Addressing childhood obesity in ethnic minority populations

Abstract

Childhood obesity in the UK is a serious public health concern. In some ethnic minority groups obesity prevalence is significantly higher than the national average (The NHS Information Centre, 2010). Therefore, it is recommended that interventions to manage childhood obesity are tailored to the needs of ethnic minority groups (NICE, 2006). GOALS (Getting Our Active Lifestyles Started!) is a community based, childhood obesity management programme that focuses upon physical activity, nutrition and behaviour change in families (Watson et aI., 2011). However, monitoring data has suggested an unrepresentatively low proportion of ethnic minority families who are referred to GOALS choose to access the service. Therefore the aim of this research was to improve the cultural relevance of the GOALS programme, whilst also contributing to the evidence-base for local and national strategic planning surrounding obesity and ethnicity. Studies set out to explore perceptions surrounding childhood weight, diet and physical activity in different ethnic groups; identify cultural preferences, and barriers to participation in healthy lifestyle interventions; to implement and pilot a culturally accessible intervention, using the GOALS framework for development; and to assess the acceptability and effectiveness of the pilot intervention. A multi-method, pluralistic, research design was employed that recognised the complexity of the research aims. In total three empirical studies were conducted, and parents (of children aged 4 to 16 years) and school-aged children participated. A combination of process and outcome data was obtained. Quantitative methods were used for descriptive and explanatory purposes and included questionnaire (Study 1,2 and 3b) and BMI measures (Study 3b). Qualitative methods included focus groups (Study 2 and 3a), face-to-face interviews (Study 3b) and the write-and draw-technique (Study 3b). Exploratory data gave context and depth to the research. In Study 1, parents (n=808) identified their ethnic background as Asian British, Black African, Black Somali, Chinese, South Asian, White British and Yemeni. Ethnic background was significantly associated to parental perceptions of weight in childhood. Results showed Black Somali parents exhibited the lowest level of concern for overweight in childhood in comparison to other ethnic groups. In Study 2, parents (n=36) and children (n=31) from six ethnic groups (Asian Bangladeshi, Black African, Black Somali, Chinese, White British and Yemeni) identified intrapersonal, interpersonal and environmental barriers to healthy weight. Findings demonstrated that influences to health behaviours were sometimes specific to particular ethnic groups. For example, dominant cultural norms valuing overweight in childhood were apparent among Yemeni, Black African, Black Somali and Asian Bangladeshi parents and Asian Bangladeshi children. Results from Study 3a with parents (n=33) from ethnically diverse backgrounds, identified barriers and preferences to attending an intervention were often related to cultural and religious values of ethnic groups. Parents considered the ethnic composition of the group important, and suggested an intervention should be relevant to the ethnic background of all families attending. Based on these findings, 'surface' and 'deep' (Reniscow et al., 1999) structural modifications were made to the GOALS programme. Nine families from Asian British, Asian Bangladeshi, Yemeni and Black Somali backgrounds attended the pilot intervention to examine its appropriateness. Process and outcome data from Study 3b illustrated families benefited from a healthy lifestyles intervention that was designed to be culturally acceptable to multiple ethnic groups. This thesis has added to the limited evidence base surrounding the cultural relevance of family-based childhood obesity management programmes for ethnic minority groups. Differences in cultural norms between ethnic populations, and variations in assimilation to Western norms and acculturation within groups, highlight the complex task in addressing childhood obesity in multiple ethnic groups. Knowledge gained from the successful engagement of ethnic minority families in a culturally sensitive healthy lifestyle intervention, has lead to the development of key recommendations for policy and practice that extend beyond childhood obesity management to health promotion more widely.